ORIGINAL ARTICLE
Year : 1991 | Volume
: 39 | Issue : 4 | Page : 174--175
Anti-insulin antibodies and retinopathy in juvenile onset type-1 diabetes
K Sharma, PK Khosla, HK Tiwari, RK Sharma, JS Bajaj
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, Department of Medicine, Department of Anatomy, All Institute of Medical Sciences, New Delhi, India
Correspondence Address:
K Sharma
Department of Neuro-Ophthalmology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Post Box 375, Lucknow - 226001
India
Abstract
Juvenile diabetics have severe loss of beta cell function and require replacement therapy with insulin. Insulin antigenicity can produce anti-insulin antibodies resulting in allergic reactions and insulin resistance. The role of insulin-anti-insulin antibody complexes in the development and progress of chronic diabetic complications like microangiopathy is not very clear. In the present study, there was statistically a significant trend of higher insulin antibody binding levels in IDDM patients who developed retinopathy. Though there was a trend of higher insulin antibody in IDDM patients with retinopathy, there was no association between insulin antibody and HLA antigen which some authors have reported.
How to cite this article:
Sharma K, Khosla P K, Tiwari H K, Sharma R K, Bajaj J S. Anti-insulin antibodies and retinopathy in juvenile onset type-1 diabetes.Indian J Ophthalmol 1991;39:174-175
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How to cite this URL:
Sharma K, Khosla P K, Tiwari H K, Sharma R K, Bajaj J S. Anti-insulin antibodies and retinopathy in juvenile onset type-1 diabetes. Indian J Ophthalmol [serial online] 1991 [cited 2023 Sep 30 ];39:174-175
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1991/39/4/174/24429 |
Full Text
INTRODUCTION
Juvenile diabetics have severe loss of beta cell function and require replacement therapy with insulin. Insulin antigenicity can produce anti-insulin antibodies resulting in allergic reactions [1] and insulin resistance [2] The role of insulin-anti-insulin antibody complexes in the development and progress of chronic diabetic complications like microangiopathy is not very clear. The present study investigates the relationship be�tween anti-insulin antibody and retinopathy in insulin dependent diabetes mellitus (IDDM).
MATERIAL AND METHODS
Thirty five patients of IDDM were studied for the presence of diabetic retinopathy by fluorescein an�giography. They were divided into various groups depending on the severity of retinopathy [3]: Group I-no retinopathy (20 patients); Group II with retinopathy (15 patients) further subdivided into Ila - mild retinopathy (6 patients) and Ilb - severe retinopathy (proliferative and maculopathy, 9 patients).
Patients showing loss of beta cell function indicated by low serum C peptide immunoreactivity (RIA kit,Novo Research Institute, Denmark) and low serum immunoreactive insulin [4]; both baseline and after glucose load, were included in the study.
Serum insulin antibody: Fasting blood samples were analysed for insulin antibody by radioimmunoassay (RIA) [5]. Percentage of insulin binding was determined by a RIA procedure usin dextran coated charcoal method and titration with 125 insulin (monocomponent porcine insulin; Novo Research Institute, Im�munochemical Laboratory, Denmark). Percentage of insulin antibody binding was estimated in undiluted serum and after dilutions i.e. 1:10, 1:50 and 1:100.
The patients also underwent HLA typing for A,B,C loci by two stage microlymphocytotoxicity method of Terasaki and McClelland [6].
OBSERVATION
Insulin antibody binding: The binding of 125 labelled pork insulin by the serum sample in IDDM (35 patients), were expressed as percent of labelled insulin bound [Figure 1]. Sixty percent of patients with retinopathy and only 20% without retinopathy had moderate or high serum insulin binding levels. This difference was statistically significant ([Table 1]. P>0.05). Mean values of percentage of insulin an�tibody binding in retinopathy group was also higher than the no-retinopathy group [Table 2], but this failed to reach statistical significance.
HLA and anti-insulin antibodies: There was no sig�nificant association between any HLA antigen and insulin binding [Table 3].
DISCUSSION
Some workers have suggested that immune com�plexes may play a role in the degenerative diseases of diabetes including microangiopathy [7]. The antigen antibody complexes in the plasma of diabetics are partially due to insulin and its antibodies [8]. Cytotoxic immune complexes could be formed as a combination of high affinity insulin antibody with previously se-questered insulin in the vascular wall.
In the present study, there was statistically a sig�nificant trend of higher insulin antibody binding levels in IDDM patients who developed retinopathy [Table 1]. Anderson [9] has also found that the frequency of high insulin antibody titre was significantly greater among diabetics with complications like retinopathy and insulin-antinsulin antibody complexes may be involved in aggravating the microvascular pathology. Other workers have failed to find such a relationship [10]
Evidence is slim but increasing to support that diabetic microangiopathy may be caused or ac�celerated by immune complexes. Atkins et al [11] have found strong correlation between the insulin antibody and islet cell antibody and presence of both increased the likelihood of autoimmune phenomenon.
HLA and insulin antibody: The susceptibility to retinopathy in IDDM has been correlated with par�ticular HLA antigens [12]. The possibility that this could be mediated by production of insulin antibodies has been investigated. In our present study, though there was a trend of higher insulin antibody in IDDM patients with retinopathy, there was no association between insulin antibody and HLA antigen [Table 3]. Some workers [10] have found such an association with HLA 15 but others have failed to confirm it [13] In conclusion, the higher levels of anti-insulin antibody seen in patients of IDDM with retinopathy did not show any association with HLA. It remains speculative whether raised levels of anti-insulin antibody have a role to play in either initiation or aggravation of retinopathy or alternatively they may simply be a reflection of non specific secondary tissue damage
SUMMARY :
Thirty five patients of insulin dependent diabetes mellitus (IDDM) were investigated for retinopathy by fluorescein angiography. Serum levels of insulin an�tibody binding were correlated with the retinopathy. Patients with retinopathy had a trend towards higher serum insulin antibody binding levels which was statistically significant. There was no association between HLA phenotypes and the insulin antibody levels.
References
| 1 | Kumar, D.. 1977, J. Clin. Endocrinol. Metab, 45:1159. |
| 2 | Andersen, O.O., 1975, Acta Endocrinol. 78:723. |
| 3 | Leslie, R.D.G., Barnett, A.H., Pyke, D.A., 1979. Lancet, 1;997. |
| 4 | Khardori, R., Bajaj. J.S., Deo, M.G., Bansal, D.O., 1980, J. Endocrine Invest., 3:273. |
| 5 | Bersen, S.A., Yalow, R.S., 1962, Immunoassay of hormones. Ciba Foundation on Endocrinology.. Vol.14, Churchill. London. |
| 6 | Terasaki, PI., McClellamd, J.D., 1964, Nature, 204:998. |
| 7 | Berns. A. W., Owens, C T., Hirata, Y., Blumenthal. H.T., 1962, Diabetes. 11:308. |
| 8 | DiMario. U., lavicoli, M., Andereani, U., 1980 Diabetologica, 19:89. |
| 9 | Andersen. O.O.. 1976, Acta Endrocrinol.. 83:329. |
| 10 | Gray. R.S., Starkey, I.R., Rainbow, S., Kurtz, A.B., Abdel Khalik, A..Urabanik, S.. Elton. R.A.. Duncan, L.J.P. Clarke, B.F., 1982 Br. J. Ophthalmol., 66:280. |
| 11 | Atlins, M.A.. Maclarem, N.K., Riley, W.J., Winter, W.E., Fisk, D.D., Spillar, R.P. 1986, Diabetes. 35:894. |
| 12 | Barbosa. J., Ramsay, R. C., Knobloch, W.C., 1980, Am. J. Ophthalmol.90:148. |
| 13 | Bodansky, H.J., Wolf, E., Cudworth. A.G., Dean B.M., Nineham, L.J., Bottazzo, G.F, Mathews, J.A., Kurtz, A.B., Kohner, E.M. 1982, Diabetes, 31:70. |
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